Objective To investigate the morphological changes of the proximalfemur and their implication to the total hip arthroplasty in patients with Crowe Ⅱ/Ⅲ developmental dysplasia of the hip (DDH). Methods The experimental gr oup was composed of 15 hips in 14 patients (Crowe Ⅱ, 9 hips; Crowe Ⅲ, 6 hips ) with osteoarthritis secondary to Crowe Ⅱ/Ⅲ DDH (2 males, 12 females; age, 35-61 years). None of the patients had accepted any osteotomy treatment. The control group was composed of 15 normal hips in 15 patients with unilateral DDH (3 males, 12 females; age, 35-57 years). Twelve hips came from the experimental group and the other 3 came from the patients with unilateral Crowe Ⅰ DDH. The femurswere examined with the CT scanning. The following parameters were measured: theheight of the center of the femoral head (HCFH), the isthmus position (IP), theneckshaft angle(NS), the anteversion angle, the canal flare index, and the canal width. Then, the analysis of the data was conducted. Results HCFH and IP in theexperimental group and the control group were 50.1±6.7 mm, 50.1±7.4 mm, and 107.4±21.5 mm, 108.7±18.1 mm，respectively, which had no significant differencebetween the two groups（Pgt;0.05）. In the experimental group and the control group, the NS were 138.3±10.0° and 126.7±5.7°，the anteversion angles were 36.5±15.9° and 18.8±5.4°, and the canal flare indexes were 4.47±0.40and 5.01±0.43. There was a significant difference between the two groups in the above 3 parameters （Plt;0.05）. As for the canal width of the femur, therewasa significant difference in the interior/exterior widths and the anterior/posterior widths at the level of 2 cm above the lesser trochanter and 4 cm belowthe lesser trochanter between the two groups （Plt;0.05）; however, there was nosignificant difference in the canal width of the femur at the isthmus between the two groups（P＞0.05）. Conclusion It is necessary to evaluate the morphology of the proximal femur before the total hip arthroplasty performed in patients with Crowe Ⅱ/Ⅲ DDH. The straight and smaller femoral prosthesis should be chosen and implanted in the proper anteversion position duringoperation.
Objective To evaluate the efficacy of total hip arthroplasty (THA) combined with femoral head autograft for Crowe type II and type III developmental dysplasia of the hip (DDH). Methods From January 2001 to January 2004, THA was performed for 23 patients (29 hips) with osteoarthritis secondary to DDH. There were 20 females (26 hips) and 3 males (3 hips) with an average age of 52 years (range 43-65 years). Unilateral DDH occurred in 17 patients and bilateral DDH occurred in6 patients. Based on radiographic classification of Crowe, there were 17 cases (20 hips) of type II and 6 cases (9 hips) of type III. The length difference was (2.9 ± 0.8) cm between two lower l imbs of the unilateral DDH patients. The Harris scores were 43.6 ± 13.8 preoperatively. The standard procedure of THA was performed in 3 patients (4 hips), the structural femoral head autograft for restoring normal level of rotating center of the acetabulum in other patients. Results The incision healed by first intention in all patients. No patient suffered compl ications after operation. The duration of follow-up ranged from 4 to 7 years (average 5.6 years). The X-ray films showed bony heal ing between the grafted bone and the il ium in all patients. At last follow-up, the length difference was (0.9 ± 0.2) cm between two lower l imbs and the Harris score was 86.3 ± 6.4; showing statistically differences (P lt; 0.05) when compared with preoperation. The X-ray films showed no dislocation of acetabulum, and femoral prosthesis, and no signs of dislocation, absorption and collapse of the grafted bone. Conclusion THA combined with structural femoral head autograft for patients with osteoarthritis secondary to DDH can obtain favorable results. This method can restore normal level of rotating center of the acetabulum, provide rel iable acetabular fixation, and restore acetabular bone stock in patients with Crowe type II and type III DDH.
Objective To compare the biomechanical effects between rotational acetabular osteotomy and Chiari osteotomy for developmental dysplasia of the hip (DDH) by biomechanical test. Methods Sixteen DDH models of 8 human cadaver specimens were prepared by resecting the upper edge and posterior edge of acetabulum. And the Wiberg central-edge angle (CE) of the DDH model was less than 20°. Then the rotational acetabular osteotomy was performed on the left hip and Chiari osteotomy on the right hip. When 600 N loading was loaded at 5 mm/minute by a material testing machine, the strain values of normal specimens, DDH specimens, and 2 models after osteotomies were measured. Results In normal specimens, the strain values of the left and right hips were 845.63 ± 533.91 and 955.94 ± 837.42 respectively, while the strain values were 1 439.03 ± 625.23 and 1 558.75 ± 1 009.46 respectively in DDH specimens, which was about 2 times that of normal hips. The morphology and X-ray examinations indicated that the DDH model was successfully established. The strain value was 574.94 ± 430.88 after rotational acetabular osteotomy, and was significantly lower than that of DDH specimens (t=4.176, P=0.004); the strain value was 1 614.81 ± 932.67 after Chiari osteotomy, showing no significant difference when compared with that of DDH specimens (t=0.208, P=0.841). The strain value relieved by rotational acetabular osteotomy was significantly higher than that by Chiari osteotomy (t= — 2.548, P=0.023). Conclusion Rotational acetabular osteotomy is better than Chiari osteotomy in relieving hip joint stress of DDH.
Objective To evaluate the results of rotational acetabular osteotomy (RAO) combined with debridement under arthroscope in the treatment of adult developmental dysplasia of the hip (DDH). Methods Between April 2002 and August 2007, 24 cases (29 hips) of DDH were treated with RAO combined with debridement under arthroscope. There were 2 males (2 hips) and 22 females (27 hips) with an average age of 37.7 years (range, 21-50 years). The locations were the left hip in 7 cases, the right hip in 12 cases, and both hips in 5 cases. The course of hip pain was 8-216 months (median, 30.5 months). According to Crowe DDH classification, there were 24 hips of type I and 5 hips of type II. According to Touml;nnis hip osteoarthritis classification, there were 20 hips of stage I and 9 hips of stage II. Results The mean operation time was 150 minutes (range, 120-180 minutes); the mean intraoperative blood loss was 600 mL (range, 500-700 mL); and the mean postoperative drainage volume was 200 mL(range, 50-400 mL). All incisions healed by first intention. Twenty-four cases were followed up 4.5 years on average (range, 3-8 years). At last follow-up, claudication disappeared in 16 hips and was improved in 8 hips. The Harris hip score was improved from 79.4 ± 9.8 preoperatively to 95.1 ± 8.6 postoperatively, showing significant difference (t=2.467, P=0.010). The visual analogue scale (VAS) score was improved from 5.1 ± 0.8 preoperatively to 1.1 ± 0.6 postoperatively, showing significant difference (t=2.118, P=0.011). The X-rayfilms showed union was achieved at 12-16 weeks (mean, 13.5 weeks). There were significant differences in the centre edge angle, Sharp angle, acetabular coverage rate, and acetabulum-head index between preoperation and postoperation (P lt; 0.05). Twenty hips at Touml;nnis stage I maintained after operation, among 9 hips at Touml;nnis stage II, 5 hips was improved to stage I and 4 hips maintained. Conclusion It has a satisfactory result to treat adult DDH by RAO combined with debridement under arthroscope, which may increase the congruency of hip joint, delay or prevent the progression of hip osteoarthritis.
ObjectiveTo evaluate the effectiveness of the total hip arthroplasty (THA) for severe development dysplasia of the hip (DDH) in adults. MethodsBetween July 2007 and January 2013, 25 patients (27 hips) with severe DDH underwent THA with cementless prosthesis. There were 10 males (11 hips) and 15 females (16 hips) with an average age of 38.6 years (range, 21-57 years). The left hip was involved in 10 cases, the right hip in 13 cases, and bilateral hips in 2 cases. There were 8 cases (9 hips) of Crowe type III and 17 cases (18 hips) of Crowe type IV. The main clinical manifestations were unilateral or bilateral hip pain, claudication, and limited motion of the hip. All patients had leg discrepancy with a length difference of (4.9±0.8) cm. Harris score was 32.7±2.9. ResultsAll patients obtained primary healing of incision; no infection, dislocation, periprosthetic fracture, and lower extremity deep venous thrombosis occurred. All patients were followed up 1-5 years (mean, 3.7 years). Pain relief of the hip was obtained. The motion of the hip was improved obviously. At last follow-up, the length difference between lower limbs was (1.5±0.3) cm, showing significant difference (t=36.703,P=0.000) when compared with preoperative one. Normal gait was observed in the others except 3 cases having mild claudication. Harris score was 89.6±3.2, showing significant difference (t=-65.498,P=0.000) when compared with preoperative one. The X-ray films showed bone union of the acetabular structural bone graft and femoral osteotomy ends, and the union time was 3-5 months (mean, 4.6 months). No complication occurred as follows:dislocation, infection, prosthesis loosening or subsidence, and heterotopic ossification. ConclusionTHA in the treatment of severe DDH in adults can obtain satisfactory short-term effectiveness, but long-term effectiveness needs further observation.
ObjectiveTo explore the mid-term effectiveness of total hip arthroplasty (THA) with subtrochanteric shortening osteotomy in treatment of Crowe type Ⅳ developmental dysplasia of the hip (DDH).MethodsBetween September 2009 and March 2014, a total of 49 patients (57 hips) who were diagnosed with Crowe type Ⅳ DDH were treated with THA and subtrochanteric shortening osteotomy. Of the 49 patients, 7 were male and 42 were female with an average age of 44.6 years (range, 20-73 years). The preoperative Harris score was 44.68±3.39 and the preoperative leg length discrepancy was (5.27±0.55) cm.ResultsAll incisions healed primarily. All patients were followed up 32-87 months (mean, 52.1 months). At last follow-up, the Harris score was 85.67±2.89 and the leg length discrepancy was (1.12±0.48) cm, showing significant differences when compared with the preoperative values (t=–69.53, P=0.00; t=42.94, P=0.00). X-ray films showed that bone union of the femoral osteotomy end at 6 months after operation. There was no loosening and subsidence of prosthesis at last follow-up.ConclusionThe subtrochanteric shortening osteotomy with THA in treatment of Crowe type Ⅳ DDH can obtain satisfactory mid-term effectiveness with low risk of peripheral vascular and nerve traction injuries.
ObjectiveTo assess the effectiveness of two osteotomy methods in total hip arthroplasty (THA) for treating Crowe type ⅠV adult developmental dysplasia of the hip (DDH), trochanteric osteotomy and subtrochanteric osteotomy. MethodsA retrospective analysis was made on the clinical data of 36 patients (43 hips) with Crowe type ⅠV DDH undergoing THA between June 2007 and December 2013. In THA, 19 patients (23 hips) underwent trochanteric osteotomy (group A) and 17 patients (20 hips) underwent subtrochanteric osteotomy (group B). There was no significant difference in age, gender, body mass index, side, preoperative Harris score, and limb length difference between 2 groups (P>0.05). The operation duration, bleeding volume, hospitalization duration, intraoperative and postoperative complications were compared between 2 groups. ResultsThere was no significant difference in operation duration, bleeding volume, and hospitalization days between 2 groups (P>0.05). The rate of intraoperative complication was 21.7% (5/23) in group A and 5.0% (1/20) in group B, showing no significant difference between 2 groups (P>0.05). The rate of postoperative complications was 10.5% (2/19) in group A and 22.2% (4/18) in group B, showing no significant difference between 2 groups (P>0.05). Thirty-one patients (37 hips) were followed up 1-7 years (mean, 3 years), including 16 cases (19 hips) in group A and 15 cases (18 hips) in group B. X-ray films showed good position of the prostheses. The Harris score at last follow-up was significantly increased when compared with preoperative score in 2 groups (P<0.05), but there was no significant difference between 2 groups (P>0.05). The postoperative discrepancy of bilateral lower limbs had no significant difference (t=-1.343, P=0.188). ConclusionTHA with trochanteric osteotomy or subtrochanteric osteotomy both can effectively treat Crowe type ⅠV DDH. THA with subtrochanteric osteotomy has an advantage in correcting lower limb discrepancy.
ObjectiveTo explore the feasibility and effectiveness of total hip arthroplasty (THA) with acetabulum structural bone grafting using autogenous femoral head through direct anterior approach (DAA) in lateral decubitus position in the treatment of Crowe type Ⅲ and Ⅳ developmental dysplasia of the hip (DDH). Methods Between June 2016 and July 2020, 12 patients with Crowe type Ⅲ and Ⅳ DDH were treated with THA with acetabulum structural bone grafting using autogenous femoral head through DAA in lateral decubitus position. There were 2 males and 10 females with an average age of 60.2 years (range, 50-79 years). Crowe classification was type Ⅲ in 10 hips and type Ⅳ in 2 hips. The preoperative Harris score of hip joint was 48.8±7.5, the difference in length of both lower extremities was (3.0±0.7) cm, and the visual analogue scale (VAS) score during activity was 7.2±0.9. The surgical incision length, operation time, intraoperative blood loss, and complications were recorded; the position and press-fitting of acetabulum and femoral prosthesis were observed after operation, and the difference in length of both lower extremities was measured; the horizontal coverage of acetabular cup and bone graft were measured, the healing with the host bone and the loosening of the prosthesis were evaluated; Harris score was used to evaluate hip joint function, and VAS score was used to evaluate patients’ pain during activity. Results The average surgical incision length was 9.3 cm, the average operation time was 117 minutes, and the average intraoperative blood loss was 283 mL. Two patients (16.7%) received blood transfusion during operation. There was no acetabular and femoral fractures during operation. All incisions healed by first intention, without dislocation, periprosthetic infection, sciatic nerve injury, deep venous thrombosis, and other complications. One patient had lateral femoral cutaneous nerve injury after operation. X-ray films at discharge showed a total acetabular cup level coverage of 93%-100%, with an average of 97.8%, and a bone graft level coverage of 25%-45%, with an average of 31.1%. All the 12 patients were followed up 22-71 months, with an average of 42.2 months. At last follow-up, the Harris score of hip joint was 89.7±3.9, the difference in length of both lower extremities was (0.9±0.4) cm, and the VAS score during activity was 1.1±0.6, which were significantly different from those before operation (P<0.05). During follow-up, there was no patient who needed hip revision surgery because of prosthesis loosening. At last follow-up, there was no translucent line between the graft and the host bone, the graft was fused, the position was good, and there was no obvious movement. One patient had one screw fracture and bone resorption at the outer edge of the graft, but the bone graft did not displace and healed well. ConclusionTHA with acetabulum structural bone grafting using autogenous femoral head through DAA in lateral decubitus position in the treatment of Crowe type Ⅲ and Ⅳ DDH is safe and reliable, and has satisfactory short-term effectiveness.
ObjectiveTo evaluate the effectiveness of anatomic femoral component prosthesis for severe development dysplasia of the hip (DDH) in total hip arthroplasty (THA). MethodsBetween September 2009 and September 2013, 48 patients (51 hips) with severe DDH underwent THA with cementless anatomic femoral component prosthesis. There were 5 males (5 hips) and 43 females (46 hips) with an average age of 51 years (range, 28-67 years). The left hip was involved in 25 cases, the right hip in 20 cases, and bilateral hips in 3 cases. There were 39 cases (44 hips) of Crowe type Ⅲ and 9 cases (7 hips) of Crowe type ⅠV. The visual analogue scale (VAS) score was 5.72±1.84, and Harris score was 41.66±4.87 at preoperation. All patients had leg discrepancy with a length difference of (4.31±0.84) cm. ResultsThe duration of surgery was 59-110 minutes (mean, 78.6 minutes), and the hospitalization days were 6-20 days (mean, 12.3 days). All patients obtained primary healing of incision without wound related complications of swelling, effusion, and infection. Two patients were found to have intramuscular venous thrombosis. All patients were followed up 10-54 months (mean, 29 months). Limp was observed at the early stage after operation in 9 patients and disappeared after 1 year, the other patients had normal gait. The VAS score 1.46±0.47, Harris score 88.66±3.48, and the leg length difference (1.15±0.33) cm at last follow-up all showed significant differences when compared with the preoperative values (P<0.05). No prosthesis loosening or subsidence, heterotopic ossification, dislocation, and infection occurred. ConclusionAnatomic femoral component prosthesis for severe DDH in THA can relieve pain, and improve the hip joint function and limb discrepancy. Short-term effectiveness was satisfactory, but the long-term effectiveness should still be observed in future.
ObjectiveTo investigate the effectiveness of Bernese osteotomy for the treatment of developmental dysplasia of the hip (DDH) in adults. MethodsBetween August 2012 and April 2014, 16 patients with DDH were treated with Bernese osteotomy by S-P approach, and the clinical data were retrospectively analyzed. There were 4 males and 12 females with an average age of 27.8 years (range, 18-35 years). The left side was involved in 6 cases and the right side in 10 cases. The visual analogue scale (VAS) score was 4.8±0.5, and the Harris hip score was 81.2±5.4. The lateral center edge (CE) angle (the angle between the vertical center of the femoral head and the lateral edge of the acetabulum) was (6.5±8.7)°;the horizontal tilt angle was (25.6±5.9)°;and the femoral head extrusion index was 36.5%±6.5%. According to the Tonnis osteoarthritis classification, 12 hips were rated as Grade 0, 3 hips as Grade I, and 1 hip as Grade II. ResultsThe operation time was 90-135 minutes;the intraoperative blood loss was 400-800 mL;10 cases accepted blood transfusion and the amount of blood transfusion was 200-600 mL;the postoperative drainage volume was 100-300 mL;and the hospitalization time was 7-12 days. All the cases achieved primary healing of incision with no early complications. Two cases had numb in the lateral femoral cutaneous nerve innervating area. All patients were followed up 12-26 months (mean, 20 months). The X-ray examination showed osseous healing at osteotomy site, and the healing time was 12-16 weeks (mean, 13.5 weeks). No acetabulum fracture, heterotopic ossification, osteonecrosis, and internal fixation loosening occurred during follow-up. No progression of osteoarthritis or acetabular cystic change was observed. At last follow-up, the lateral CE angle was (27.7±6.8)°;the horizontal tilt angle was (16.2±4.8)°;the femoral head extrusion index was 19.7%±5.3%;VAS score was 0.8±0.3;the Harris hip score was 96.8±6.7;and all showed significant differences when compared with preoperative ones (P<0.05). ConclusionFor DDH adults, Bernese osteotomy can effectively increase the acetabulum tolerance, improve the joint function, and slow progress in osteoarthritis, and the short-term effectiveness is satisfactory.